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An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)

BACKGROUND: Modern chemotherapeutics have led to improved systemic disease control for patients with locally advanced pancreatic cancer (LAPC). Surgical strategies such as distal pancreatectomy with celiac axis resection (DP-CAR) are increasingly entertained. Herein we review procedure specific outc...

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Autores principales: Schmocker, Ryan K., Wright, Michael J., Ding, Ding, Beckman, Michael J., Javed, Ammar A., Cameron, John L., Lafaro, Kelly J, Burns, William R., Weiss, Matthew J., He, Jin, Wolfgang, Christopher L., Burkhart, Richard A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041923/
https://www.ncbi.nlm.nih.gov/pubmed/33051739
http://dx.doi.org/10.1245/s10434-020-09201-2
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author Schmocker, Ryan K.
Wright, Michael J.
Ding, Ding
Beckman, Michael J.
Javed, Ammar A.
Cameron, John L.
Lafaro, Kelly J
Burns, William R.
Weiss, Matthew J.
He, Jin
Wolfgang, Christopher L.
Burkhart, Richard A.
author_facet Schmocker, Ryan K.
Wright, Michael J.
Ding, Ding
Beckman, Michael J.
Javed, Ammar A.
Cameron, John L.
Lafaro, Kelly J
Burns, William R.
Weiss, Matthew J.
He, Jin
Wolfgang, Christopher L.
Burkhart, Richard A.
author_sort Schmocker, Ryan K.
collection PubMed
description BACKGROUND: Modern chemotherapeutics have led to improved systemic disease control for patients with locally advanced pancreatic cancer (LAPC). Surgical strategies such as distal pancreatectomy with celiac axis resection (DP-CAR) are increasingly entertained. Herein we review procedure specific outcomes and assess biologic rationale for DP-CAR. METHODS: A prospectively maintained single-institution database of all pancreatectomies was queried for patients undergoing DP-CAR. We excluded all patients for whom complete data were not available and those who were not treated with contemporary multi-agent therapy. Data was supplemented with dedicated chart review and outreach for long-term oncologic outcomes. RESULTS: Fifty-four patients underwent DP-CAR between 2008–2018. The median age was 62.7 years. 98% received induction chemotherapy. Arterial reconstruction was performed in 17% and concomitant visceral resection in 30%. R0 resection rate was 87%. Postoperative complications were common (43%) with chyle leak being the most frequent (17%). Length of stay was 8 days, readmission occurred in one-third, and ninety-day mortality was 2%. Disease recurrence occurred in 74% during a median follow up of 17.4 months. Median recurrence-free (RFS) and overall survival (OS) were 9 and 25 months, respectively. CONCLUSIONS: Following modern induction paradigms, DP-CAR can be performed with low mortality, manageable morbidity, and excellent rates of margin-negative resection in high volume settings. The profile of complications of DP-CAR is distinct from pancreaticoduodenectomy and simple distal pancreatectomy. OS and RFS are similar to those undergoing resection of borderline resectable and resectable disease. Improved systemic disease control will likely lead to increasing utilization of aggressive surgical approaches to LAPC.
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spelling pubmed-80419232022-06-01 An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR) Schmocker, Ryan K. Wright, Michael J. Ding, Ding Beckman, Michael J. Javed, Ammar A. Cameron, John L. Lafaro, Kelly J Burns, William R. Weiss, Matthew J. He, Jin Wolfgang, Christopher L. Burkhart, Richard A. Ann Surg Oncol Article BACKGROUND: Modern chemotherapeutics have led to improved systemic disease control for patients with locally advanced pancreatic cancer (LAPC). Surgical strategies such as distal pancreatectomy with celiac axis resection (DP-CAR) are increasingly entertained. Herein we review procedure specific outcomes and assess biologic rationale for DP-CAR. METHODS: A prospectively maintained single-institution database of all pancreatectomies was queried for patients undergoing DP-CAR. We excluded all patients for whom complete data were not available and those who were not treated with contemporary multi-agent therapy. Data was supplemented with dedicated chart review and outreach for long-term oncologic outcomes. RESULTS: Fifty-four patients underwent DP-CAR between 2008–2018. The median age was 62.7 years. 98% received induction chemotherapy. Arterial reconstruction was performed in 17% and concomitant visceral resection in 30%. R0 resection rate was 87%. Postoperative complications were common (43%) with chyle leak being the most frequent (17%). Length of stay was 8 days, readmission occurred in one-third, and ninety-day mortality was 2%. Disease recurrence occurred in 74% during a median follow up of 17.4 months. Median recurrence-free (RFS) and overall survival (OS) were 9 and 25 months, respectively. CONCLUSIONS: Following modern induction paradigms, DP-CAR can be performed with low mortality, manageable morbidity, and excellent rates of margin-negative resection in high volume settings. The profile of complications of DP-CAR is distinct from pancreaticoduodenectomy and simple distal pancreatectomy. OS and RFS are similar to those undergoing resection of borderline resectable and resectable disease. Improved systemic disease control will likely lead to increasing utilization of aggressive surgical approaches to LAPC. 2020-10-13 2021-06 /pmc/articles/PMC8041923/ /pubmed/33051739 http://dx.doi.org/10.1245/s10434-020-09201-2 Text en https://creativecommons.org/licenses/by/4.0/Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aam-terms-v1
spellingShingle Article
Schmocker, Ryan K.
Wright, Michael J.
Ding, Ding
Beckman, Michael J.
Javed, Ammar A.
Cameron, John L.
Lafaro, Kelly J
Burns, William R.
Weiss, Matthew J.
He, Jin
Wolfgang, Christopher L.
Burkhart, Richard A.
An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)
title An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)
title_full An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)
title_fullStr An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)
title_full_unstemmed An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)
title_short An Aggressive Approach to Locally Confined Pancreatic Cancer: Defining Surgical and Oncologic Outcomes Unique to Pancreatectomy with Celiac Axis Resection (DP-CAR)
title_sort aggressive approach to locally confined pancreatic cancer: defining surgical and oncologic outcomes unique to pancreatectomy with celiac axis resection (dp-car)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041923/
https://www.ncbi.nlm.nih.gov/pubmed/33051739
http://dx.doi.org/10.1245/s10434-020-09201-2
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